Prognostic significance of circadian variability of RR and QT intervals and QT dynamicity in patients with chronic heart failure

Eiichi Watanabe, Tomoharu Arakawa, Tatsushi Uchiyama, Mao Qing Tong, Kenji Yasui, Hiroshi Takeuchi, Toshiaki Terasawa, Itsuo Kodama, Hitoshi Hishida

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

Background: In patients with chronic heart failure (CHF), circadian variability of RR and QT intervals may be altered because of neurohumoral activation and functional and structural remodeling of the heart. Objective: The aim of this study was to evaluate the prognostic significance of circadian variability of the RR and QT intervals and QT dynamicity (QT/RR slope) in CHF patients. Methods: We prospectively enrolled 121 patients with stable CHF in sinus rhythm (age 67 ± 14 years, mean ± SD; range 34 to 87 years). The RR, QT, and rate-corrected QT (QTc) intervals and the QT/RR slope measured from 24-hour Holter electrocardiogram were fitted by cosine curves. Results: During the follow-up period of 34 ± 17 months, 40 (33%) patients died of cardiac causes, 10 of which were sudden. All patients showed significant circadian rhythms in the RR, QT, and QTc intervals and the QT/RR slope by cosine-curve fitting. In addition to the expected higher heart rate, longer QT interval, and steeper QT/RR slope, we found that patient who died of cardiac causes had reduced circadian variability of QT interval (10 ± 10 ms vs 21 ± 13 ms) and a later maximum RR interval (4.1 ± 0.9 AM vs 2.3 ± 2.1 AM) compared with survivors, among many other statistically significant circadian parameter differences. These 2 parameters were independent predictors of cardiac death in multivariate Cox proportional hazards regression analysis. Conclusion: Circadian variability analyses of Holter-derived RR and QT intervals may provide prognostic information beyond that provided by 24-hour averages of these parameters.

Original languageEnglish
Pages (from-to)999-1005
Number of pages7
JournalHeart Rhythm
Volume4
Issue number8
DOIs
Publication statusPublished - 01-08-2007

Fingerprint

Heart Failure
Circadian Rhythm
Survivors
Electrocardiography
Heart Rate
Regression Analysis

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Watanabe, Eiichi ; Arakawa, Tomoharu ; Uchiyama, Tatsushi ; Tong, Mao Qing ; Yasui, Kenji ; Takeuchi, Hiroshi ; Terasawa, Toshiaki ; Kodama, Itsuo ; Hishida, Hitoshi. / Prognostic significance of circadian variability of RR and QT intervals and QT dynamicity in patients with chronic heart failure. In: Heart Rhythm. 2007 ; Vol. 4, No. 8. pp. 999-1005.
@article{4b0e176d143b4b05a02c897c926ccce9,
title = "Prognostic significance of circadian variability of RR and QT intervals and QT dynamicity in patients with chronic heart failure",
abstract = "Background: In patients with chronic heart failure (CHF), circadian variability of RR and QT intervals may be altered because of neurohumoral activation and functional and structural remodeling of the heart. Objective: The aim of this study was to evaluate the prognostic significance of circadian variability of the RR and QT intervals and QT dynamicity (QT/RR slope) in CHF patients. Methods: We prospectively enrolled 121 patients with stable CHF in sinus rhythm (age 67 ± 14 years, mean ± SD; range 34 to 87 years). The RR, QT, and rate-corrected QT (QTc) intervals and the QT/RR slope measured from 24-hour Holter electrocardiogram were fitted by cosine curves. Results: During the follow-up period of 34 ± 17 months, 40 (33{\%}) patients died of cardiac causes, 10 of which were sudden. All patients showed significant circadian rhythms in the RR, QT, and QTc intervals and the QT/RR slope by cosine-curve fitting. In addition to the expected higher heart rate, longer QT interval, and steeper QT/RR slope, we found that patient who died of cardiac causes had reduced circadian variability of QT interval (10 ± 10 ms vs 21 ± 13 ms) and a later maximum RR interval (4.1 ± 0.9 AM vs 2.3 ± 2.1 AM) compared with survivors, among many other statistically significant circadian parameter differences. These 2 parameters were independent predictors of cardiac death in multivariate Cox proportional hazards regression analysis. Conclusion: Circadian variability analyses of Holter-derived RR and QT intervals may provide prognostic information beyond that provided by 24-hour averages of these parameters.",
author = "Eiichi Watanabe and Tomoharu Arakawa and Tatsushi Uchiyama and Tong, {Mao Qing} and Kenji Yasui and Hiroshi Takeuchi and Toshiaki Terasawa and Itsuo Kodama and Hitoshi Hishida",
year = "2007",
month = "8",
day = "1",
doi = "10.1016/j.hrthm.2007.04.019",
language = "English",
volume = "4",
pages = "999--1005",
journal = "Heart Rhythm",
issn = "1547-5271",
publisher = "Elsevier",
number = "8",

}

Watanabe, E, Arakawa, T, Uchiyama, T, Tong, MQ, Yasui, K, Takeuchi, H, Terasawa, T, Kodama, I & Hishida, H 2007, 'Prognostic significance of circadian variability of RR and QT intervals and QT dynamicity in patients with chronic heart failure', Heart Rhythm, vol. 4, no. 8, pp. 999-1005. https://doi.org/10.1016/j.hrthm.2007.04.019

Prognostic significance of circadian variability of RR and QT intervals and QT dynamicity in patients with chronic heart failure. / Watanabe, Eiichi; Arakawa, Tomoharu; Uchiyama, Tatsushi; Tong, Mao Qing; Yasui, Kenji; Takeuchi, Hiroshi; Terasawa, Toshiaki; Kodama, Itsuo; Hishida, Hitoshi.

In: Heart Rhythm, Vol. 4, No. 8, 01.08.2007, p. 999-1005.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Prognostic significance of circadian variability of RR and QT intervals and QT dynamicity in patients with chronic heart failure

AU - Watanabe, Eiichi

AU - Arakawa, Tomoharu

AU - Uchiyama, Tatsushi

AU - Tong, Mao Qing

AU - Yasui, Kenji

AU - Takeuchi, Hiroshi

AU - Terasawa, Toshiaki

AU - Kodama, Itsuo

AU - Hishida, Hitoshi

PY - 2007/8/1

Y1 - 2007/8/1

N2 - Background: In patients with chronic heart failure (CHF), circadian variability of RR and QT intervals may be altered because of neurohumoral activation and functional and structural remodeling of the heart. Objective: The aim of this study was to evaluate the prognostic significance of circadian variability of the RR and QT intervals and QT dynamicity (QT/RR slope) in CHF patients. Methods: We prospectively enrolled 121 patients with stable CHF in sinus rhythm (age 67 ± 14 years, mean ± SD; range 34 to 87 years). The RR, QT, and rate-corrected QT (QTc) intervals and the QT/RR slope measured from 24-hour Holter electrocardiogram were fitted by cosine curves. Results: During the follow-up period of 34 ± 17 months, 40 (33%) patients died of cardiac causes, 10 of which were sudden. All patients showed significant circadian rhythms in the RR, QT, and QTc intervals and the QT/RR slope by cosine-curve fitting. In addition to the expected higher heart rate, longer QT interval, and steeper QT/RR slope, we found that patient who died of cardiac causes had reduced circadian variability of QT interval (10 ± 10 ms vs 21 ± 13 ms) and a later maximum RR interval (4.1 ± 0.9 AM vs 2.3 ± 2.1 AM) compared with survivors, among many other statistically significant circadian parameter differences. These 2 parameters were independent predictors of cardiac death in multivariate Cox proportional hazards regression analysis. Conclusion: Circadian variability analyses of Holter-derived RR and QT intervals may provide prognostic information beyond that provided by 24-hour averages of these parameters.

AB - Background: In patients with chronic heart failure (CHF), circadian variability of RR and QT intervals may be altered because of neurohumoral activation and functional and structural remodeling of the heart. Objective: The aim of this study was to evaluate the prognostic significance of circadian variability of the RR and QT intervals and QT dynamicity (QT/RR slope) in CHF patients. Methods: We prospectively enrolled 121 patients with stable CHF in sinus rhythm (age 67 ± 14 years, mean ± SD; range 34 to 87 years). The RR, QT, and rate-corrected QT (QTc) intervals and the QT/RR slope measured from 24-hour Holter electrocardiogram were fitted by cosine curves. Results: During the follow-up period of 34 ± 17 months, 40 (33%) patients died of cardiac causes, 10 of which were sudden. All patients showed significant circadian rhythms in the RR, QT, and QTc intervals and the QT/RR slope by cosine-curve fitting. In addition to the expected higher heart rate, longer QT interval, and steeper QT/RR slope, we found that patient who died of cardiac causes had reduced circadian variability of QT interval (10 ± 10 ms vs 21 ± 13 ms) and a later maximum RR interval (4.1 ± 0.9 AM vs 2.3 ± 2.1 AM) compared with survivors, among many other statistically significant circadian parameter differences. These 2 parameters were independent predictors of cardiac death in multivariate Cox proportional hazards regression analysis. Conclusion: Circadian variability analyses of Holter-derived RR and QT intervals may provide prognostic information beyond that provided by 24-hour averages of these parameters.

UR - http://www.scopus.com/inward/record.url?scp=34547403306&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=34547403306&partnerID=8YFLogxK

U2 - 10.1016/j.hrthm.2007.04.019

DO - 10.1016/j.hrthm.2007.04.019

M3 - Article

C2 - 17675071

AN - SCOPUS:34547403306

VL - 4

SP - 999

EP - 1005

JO - Heart Rhythm

JF - Heart Rhythm

SN - 1547-5271

IS - 8

ER -